Department of Environmental Health Sciences Columbia University Mailman School of Public Health New York NY.
Division of Nephrology Massachusetts General Hospital Boston MA.
J Am Heart Assoc. 2022 Mar 15;11(6):e024648. doi: 10.1161/JAHA.121.024648. Epub 2022 Mar 1.
Background EDTA is an intravenous chelating agent with high affinity to divalent cations (lead, cadmium, and calcium) that may be beneficial in the treatment of cardiovascular disease (CVD). Although a large randomized clinical trial showed benefit, smaller studies were inconsistent. We conducted a systematic review of published studies to examine the effect of repeated EDTA on clinical outcomes in adults with CVD. Methods and Results We searched 3 databases (MEDLINE, Embase, and Cochrane) from database inception to October 2021 to identify all studies involving EDTA treatment in patients with CVD. Predetermined outcomes included mortality, disease severity, plasma biomarkers of disease chronicity, and quality of life. Twenty-four studies (4 randomized clinical trials, 15 prospective before/after studies, and 5 retrospective case series) assessed the use of repeated EDTA chelation treatment in patients with preexistent CVD. Of these, 17 studies (1 randomized clinical trial) found improvement in their respective outcomes following EDTA treatment. The largest improvements were observed in studies with high prevalence of participants with diabetes and/or severe occlusive arterial disease. A meta-analysis conducted with 4 studies reporting ankle-brachial index indicated an improvement of 0.08 (95% CI, 0.06-0.09) from baseline. Conclusions Overall, 17 studies suggested improved outcomes, 5 reported no statistically significant effect of treatment, and 2 reported no qualitative benefit. Repeated EDTA for CVD treatment may provide more benefit to patients with diabetes and severe peripheral arterial disease. Differences across infusion regimens, including dosage, solution components, and number of infusions, limit comparisons across studies. Additional research is necessary to confirm these findings and to evaluate the potential mediating role of metals. Registration URL: https://www.crd.york.ac.uk/; Unique identifier: CRD42020166505.
EDTA 是一种与二价阳离子（铅、镉和钙）具有高亲和力的静脉内螯合剂，可能有益于心血管疾病（CVD）的治疗。尽管一项大型随机临床试验显示出益处，但较小的研究结果并不一致。我们进行了系统评价，以检查重复 EDTA 对 CVD 成人患者临床结局的影响。
我们从数据库建立之初到 2021 年 10 月在 3 个数据库（MEDLINE、Embase 和 Cochrane）中进行了检索，以确定所有涉及 CVD 患者 EDTA 治疗的研究。预定的结局包括死亡率、疾病严重程度、疾病慢性的血浆生物标志物和生活质量。24 项研究（4 项随机临床试验、15 项前瞻性前后研究和 5 项回顾性病例系列研究）评估了重复 EDTA 螯合治疗在患有预先存在的 CVD 的患者中的应用。其中，17 项研究（1 项随机临床试验）发现 EDTA 治疗后各自的结局得到改善。在参与者中糖尿病和/或严重阻塞性动脉疾病患病率较高的研究中观察到最大的改善。对 4 项报告踝臂指数的研究进行的荟萃分析表明，与基线相比，改善了 0.08（95%CI，0.06-0.09）。
总体而言，17 项研究表明改善了结局，5 项研究报告治疗无统计学显著效果，2 项研究报告无定性获益。重复 EDTA 治疗 CVD 可能会为患有糖尿病和严重外周动脉疾病的患者带来更多益处。输注方案的差异，包括剂量、溶液成分和输注次数，限制了研究之间的比较。需要进一步的研究来证实这些发现，并评估金属的潜在介导作用。
